Second Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
J Cardiovasc Electrophysiol. 2010 Jul;21(7):773-80. doi: 10.1111/j.1540-8167.2009.01702.x. Epub 2010 Feb 1.
The aim of this study was to examine autonomic disorders in patients with Brugada syndrome by performing a cardiac sympathetic innervation evaluation, a head-up tilt-test (HUT) and heart rate variability (HRV) analysis.
We enrolled 20 patients with Brugada syndrome (mean age 42.5 +/- 8.8 years), 9 with spontaneous and 11 with an induced type 1 electrocardiogram (ECG) in the setting of symptoms and 20 age-matched controls. All subjects underwent a HUT with parallel measurements of plasma catecholamines and cortisol, a (123)I-metaiodobenzylguanidine single photon emission tomography, and HRV evaluation. Ten control subjects participated in the innervation portion of the study. The tilt-test with clomipramine challenge was positive in 15 of 20 (75%) patients (7 spontaneous, 8 induced) and in 1 in controls (P < 0.01). A sympathoadrenal imbalance was shown in positive tests. The pattern of innervation in all groups was heterogenic and similar to controls with a trend towards lower measurements in patients with a spontaneous type 1 ECG and a positive HUT. HRV analysis did not reveal any significant differences during day and night. Four patients (20%) had sustained ventricular arrhythmias during a follow-up of 31.1 +/- 8.6 months, but no correlations with innervation or response to tilting were found.
A high susceptibility to vasovagal syncope was observed in patients with Brugada syndrome, which could be disease-related symptoms. Conversely, sympathetic innervation was observed to follow a physiological, heterogenic pattern; however, these factors did not have prognostic value for life-threatening arrhythmias.
本研究旨在通过心脏交感神经支配评估、头高位倾斜试验（HUT）和心率变异性（HRV）分析，检查 Brugada 综合征患者的自主神经紊乱。
我们招募了 20 名 Brugada 综合征患者（平均年龄 42.5 +/- 8.8 岁），其中 9 名有自发性和 11 名有症状诱导的 1 型心电图（ECG），20 名年龄匹配的对照组。所有患者均接受 HUT 检查，同时平行测量血浆儿茶酚胺和皮质醇、（123）I-间碘苄胍单光子发射断层扫描和 HRV 评估。10 名对照组参加了神经支配部分的研究。在 20 名患者中，有 15 名（75%）（7 名自发性，8 名诱导性）在倾斜试验中氯丙咪嗪激发阳性，对照组中只有 1 名阳性（P < 0.01）。阳性试验显示交感肾上腺失衡。所有组的神经支配模式均为异质型，与对照组相似，但自发性 1 型 ECG 和 HUT 阳性的患者测量值较低。HRV 分析在白天和夜间均未显示出任何显著差异。在 31.1 +/- 8.6 个月的随访中，有 4 名患者（20%）发生持续性室性心律失常，但未发现与神经支配或倾斜反应有关的相关性。
Brugada 综合征患者对血管迷走性晕厥的易感性较高，可能与疾病相关症状有关。相反，交感神经支配表现出一种生理的、异质的模式；然而，这些因素对危及生命的心律失常没有预后价值。
